Old and Sick in America: The Journey through the Health Care System

By Muriel R. Gillick | Go to book overview

CHAPTER SEVEN
The Hospital through Other Eyes

When I was a member of the Public Health Council, an advisory group to the Massachusetts Department of Public Health, the Council often considered proposals for new hospital construction or for the acquisition by hospitals of expensive technology. The group was charged with approving or, in rare cases, failing to approve, the granting of a coveted “Certificate of Need” that would allow the expansion to proceed. We didn’t have much of an effect on technological proliferation—our hands were tied by laws that spelled out exactly what a hospital had to do to win approval, with no provision for discretion on our part, and hospitals almost always followed the rules—but we did learn a great deal about how important hospitals are to their communities, and not just in terms of patient care.1

At one meeting, when we were considering the addition of a new wing to a hospital in Springfield, Massachusetts, the room was packed. The meetings were always open to the public and how many people attended varied depending on the level of interest in the agenda, but a full house was rare. What struck me about this meeting was that the most vocal spokespeople favoring the expansion of Bay State Medical Center, beyond the hospital’s administrators, weren’t current or prospective patients complaining about how long they had to wait in the emergency department or about the Coronary Care Unit being out of date. They weren’t staff physicians pleading for a more modern facility. The most eloquent proponents of the expansion were the construction workers who spoke of all the jobs the project would bring to the community. It was a compelling demonstration that what goes on in a hospital is important to all kinds of people because of the institution’s critical role in con temporary society. Springfield had been hit hard by the recession of 2008; its unemployment rate was higher than the state average, and the community hadn’t been thriving even in better times; but still, I was surprised to see there was greater interest in jobs than in medical care.

The trade organization for hospitals, the American Hospital Association, likes to point out just how much of a contribution hospitals make to the United States economy, quite apart from their effect on the nation’s health. In 2011 hospitals directly employed just under 5.5 million people. Adding the indirect labor—the workers in the outside laundry services that hospitals

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Old and Sick in America: The Journey through the Health Care System
Table of contents

Table of contents

  • Title Page iii
  • Contents vii
  • Prelude ix
  • Abbreviations in the Text xxi
  • Part I - The Office 1
  • Chapter One - Going to the Doctor 3
  • Chapter Two - The Lay of the Land 23
  • Chapter Three - From the outside in 41
  • Chapter Four - The March of Time, 1965–2015 61
  • Part II - The Hospital 79
  • Chapter Five - Entering the Palace of Technology 81
  • Chapter Six - The Varieties of Hospital Experience 97
  • Chapter Seven - The Hospital through Other Eyes 113
  • Chapter Eight - The Transformation of the American Hospital, 1965–2015 133
  • Part III - The Skilled Nursing Facility 151
  • Chapter Nine - Going to Rehab 153
  • Chapter Ten - Different Snfs, Different Miffs 169
  • Chapter Eleven - Movers and Shapers 184
  • Chapter Twelve - Now and Then 202
  • Finale 223
  • Acknowledgments 245
  • Notes 247
  • Bibliography 267
  • Index 293
  • Studies in Social Medicine 301
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